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TENNESSEE DEPARTMENT OF LABOR AND WORKFORCE DEVELOPMENT EMPLOYER S FIRST REPORT OF WORK INJURY OR ILLNESS JURISDICTION CLAIM # (STATE FILE #) CLAIM TYPE CODE MED ONLY INDEMNITY BECAME LOST TIME BECAME

How to fill out first report of injury

How to fill out the first report of injury:

1. Gather the necessary information: Start by collecting all relevant details about the injured person, such as their name, address, contact information, and job title. Also, note the date, time, and location of the incident.
2. Provide a detailed description: Describe the events leading up to the injury in a clear and concise manner. Include information about what the person was doing at the time, any equipment involved, and any witnesses present.
3. Record injury specifics: Document the type of injury sustained, whether it's a cut, burn, sprain, or strain, and specify the body part affected. If medical attention was required, provide relevant details about the healthcare provider and treatment received.
4. Include relevant supporting documents: Attach any supporting documents related to the incident, such as witness statements, photographs of the scene, or medical reports. These can help provide a comprehensive understanding of the situation.
5. Sign and date the report: Once the report is complete, ensure that it is signed and dated by the injured person or their representative. Additionally, make sure to sign and date your own section as the person filing the report.

Who needs the first report of injury:

The first report of injury is necessary for various parties involved in the incident and workers' compensation processes. These may include:

1. The injured person: Filing the report is crucial for the injured individual to receive proper medical treatment and support while ensuring their rights are protected.
2. The employer: The employer needs the first report of injury to fulfill their obligations under workers' compensation laws and to initiate any necessary investigations.
3. Insurance companies: Insurance providers require this report to assess the validity of the injury claim and determine the coverage and benefits available for the injured party.
4. Regulatory agencies: In many jurisdictions, reporting workplace injuries is mandated by regulatory agencies to ensure compliance with occupational safety standards and to monitor workplace safety trends.

In summary, filling out the first report of injury involves collecting and documenting all relevant information about the incident and the injured person. This report is necessary for the injured individual, their employer, insurance companies, and regulatory agencies to facilitate proper medical care, workers' compensation procedures, and overall workplace safety.

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What is first report of injury?

First report of injury is a form that documents an injury or illness that occurred in the workplace.

Who is required to file first report of injury?

Employers are required to file the first report of injury whenever an employee becomes injured or ill on the job.

How to fill out first report of injury?

First report of injury should be completed by providing detailed information about the employee, the injury or illness, and the circumstances surrounding the incident.

What is the purpose of first report of injury?

The purpose of first report of injury is to document workplace injuries and illnesses, track trends, and ensure that employees receive proper medical care and compensation.

What information must be reported on first report of injury?

Information such as employee's name, date and time of injury, location of injury, description of injury, and any witnesses must be reported on first report of injury.